I know firsthand that for many people, poverty is often related to a lack of access to basic health care, including abortion. This growing burden, carried primarily by poor people, is a blind spot for many legislatures and courts around the country.

My decision to have an abortion in 2010 wasn’t influenced by a lack of financial stability; I knew at 30 years old that I didn’t want children of my own. The circumstances that led to my unplanned pregnancy, however, were entirely due to almost a decade of living with food insecurity.

We use the word “choice” constantly in the reproductive rights movement. Almost always, this is to indicate the legal right to choose what happens to us, as though life is so easily reduced to such technicalities. But the existence of a right does not ensure that those who need to exercise it will have access to it. I didn’t choose my economic circumstances or the discrimination inherent in the pre-Affordable Care Act for-profit insurance industry, which together allowed the pregnancy to happen. So I have always bristled at the way an overuse of “choice” implies that options are a guarantee. In order for health and true equality to be in reach for all, we must understand what poverty is, who is affected by it, and deal with our discomfort as a culture acknowledging the millions who live and struggle under its weight.

When you are one of the 49 million United States residents who can’t be sure they’ll eat tomorrow or next week, every aspect of your life is about economics. The longer you live with uncertainty and instability, the more you realize that those who don’t share your experience are unaware that all issues, movements, and public policy are rooted in economic justice—or injustice. I know firsthand that for many people, poverty is often related to a lack of access to basic health care, including abortion. This growing burden, carried primarily by poor people, is a blind spot for many legislatures and courts around the country, particularly where restrictions on abortion and other kinds of reproductive care are concerned.

I was reminded of the link between health-care access and poverty yet again in the face of the justifications from the current wave of governors and state representatives proposing rules undercutting vital food assistance programs. Maine’s governor is worried about pickles; a Missouri lawmaker thinks Supplemental Nutrition Assistance Program (SNAP) recipients are living large on crab legs; and the Wisconsin legislature can’t continue to abide poor people eating potatoes and jarred pasta sauce. Every week, it seems, another lawmaker is trying to find a guilt-free way to shave one percentage point off the budget by cutting programs that keep people alive and create economic growth.

Earlier this month, when the latest of these restrictions trickled down through the media, I found myself brimming with anger in response to the stigmatizing language and the pervasive focus on the middle class with no mention of the poor. Eventually, this spilled over into a hashtag on Twitter,#PovertyIs, which managed to trend briefly, despite the rarity of this topic in public conversations. People from around the world defied stigma and shaming to share their everyday experiences with poverty—the emotion, the strain, the stress, the hunger, the physical discomfort, and the decisions our friends and neighbors don’t have to weigh constantly.

As I read the responses, I was reminded of my own abortion story—how for me, like many others, poverty meant deciding between food and other necessities. In my case, that was birth control.

Five years ago, I was still living in Chicago when the generic birth control pill began to fail at countering my monthly migraines, debilitating cramps, and other symptoms that made working on my feet impossible. So I was prescribed the NuvaRing. It worked like a charm—at almost $80 per month, because it was name-brand-only and the prescription plan I paid for out of pocket wouldn’t cover it. At a healthy, pre-existing condition-free 28 years of age in the years before the Affordable Care Act, my health care was costing me an outrageous total of $350 every month, assuming I didn’t actually use it to see a doctor or fill additional prescriptions. Following my third job loss that year, I was forced to choose between food and birth control—certainly a health “care” system failure.

When I became pregnant as a result, I was relatively lucky in terms of getting to the procedure itself. My Chicago address had made it relatively easy to access care; even though many of the clinics in the city are picketed, there are, in fact many clinics. I was also lucky to have managers and co-workers at both jobs that either understood or didn’t care that I needed a couple days off for a medical procedure. I even had my own OB-GYN with whom to discuss my circumstances. I only ended up at Planned Parenthood because my insurance didn’t cover the elective procedure, so I went where I could find a way to afford the appointment.

Still, the most expensive part of my abortion wasn’t the $400 or so I charged to my credit card at the clinic; it was the unpaid time off from four shifts at two jobs. The ACA may have improved matters in some respects by eliminating the co-pays for contraception and annual exams—for which I am very grateful every day I enjoy the freedom of my IUD—but people still have to be able to physically access a clinic in order to appreciate this policy upgrade. When doctors’ appointments require travel, time off, child care, follow-up prescriptions, follow-up appointments, and trips to the pharmacy, co-pays were never the only expense. And those of us living in poverty feel every payout. I wouldn’t have been in a position where $80 could break me if my economic circumstances had been at all stable before the prescription upgrade or losing that third job.

Recently, an unexpected medical bill led me to a new perspective on my unplanned pregnancy from five years ago. I’m one of many long-term underemployed United States residents with little-to-no room for error in my monthly budget. This latest health surprise put me over the edge completely. I wasn’t able to play bill roulette or juggle basics or max out a credit card to bridge the gap this time around, so I applied for CalFresh, California’s food assistance program.

After two years of covering the fight to keep Mississippi’s only clinic open and spending time with activists in the Rio Grande Valley, my new situation, combined with the flood of proposed SNAP restrictions and the #PovertyIs responses, has re-centered economic justice in my advocacy and reporting. It’s also refocused my abortion story, leading me to be bolder about the root causes of my unplanned pregnancy. I always cared about people’s economic circumstances, but I now have a fundamentally different relationship to those affected by abortion restrictions and to the phrase used to measure the unnecessary ordeal they endure to attain access.

The undefined, unequally applied “undue burden” standard makes the disproportionate effect of abortion restrictions on the poor especially evident. The Fifth Circuit’s most recent ruling again moves the goalposts on “undue burden” by deeming the ambulatory surgical center requirements of the Texas omnibus anti-abortion law HB 2 valid. Though the Supreme Court has stayed the ruling for now, according to advocates, if implemented, this provision of HB 2 could shutter all but nine clinics in the state.

Simply looking at the second largest state in the union on a map is enough to grasp some level of how disastrous this would be for its 27 million residents. Living in the center of West Texas already meant at least a five-hour drive in one direction or another to access a clinic in either San Antonio or New Mexico. Add in waiting periods, ultrasounds, counseling, admitting privileges that limit the number of doctors available to perform procedures in any given region, and my two days off work and $1,000 grand total in out-of-pocket cost and lost wages seems like a drop in the bucket. My ordeal five years ago was enough to go through, considering it shouldn’t have been necessary. But my white, cis, documented, able-bodied privilege all stacks up to a comparatively easy road. Even my finances were less strained thanks to timing and hard work coming together; I didn’t have $1,000 lying around to throw away, but I was able to find it.

Texas is hardly an anomaly—it’s simply a powerful visual depiction of how abortion restrictions affect a population over an enormous area. But the corridor stretching from the western border of Idaho to the eastern borders of North and South Dakota is a nearly 1,200-mile-wide clinic desert. Some states only have a single full-scale reproductive health clinic. Defunding Planned Parenthood through cuts to family planning services has caused five clinics to close in Indiana—none of which even provided abortion care. These “pro-life” policies have created a public health crisis in an area currently dealing with an HIV outbreak.

Meanwhile, on a federal level, House Republicans are attempting to eliminate Title X funding, a program that has provided millions of low-income people with STI testing, cancer screenings, contraception, and treatment since President Richard Nixon championed and signed it into law in 1970.

Nixon matter-of-factly explained why he was backing the law at the time: “It is my view that no American woman should be denied access to family planning assistance because of her economic condition.”

Almost everything seems to have changed in the past 45 years. The more I watched people on the #PovertyIs thread discuss putting off medical care despite having insurance because they couldn’t get off work or couldn’t afford the co-pays, the more absurd the debate about burden became to me. HB 2 alone has been in appeals for two years. How long does it take, exactly, for a handful of judges to decide whether 500 miles over three days or more, hundreds of dollars in lost pay and child care, and the emotional strain of navigating the ever-changing landscape is too much to put people through when they have the power to prevent all of it from happening in the first place? Why do those in power see the concept of “burden” as solely a political and/or legal issue, without direct connection to people’s economic condition?

To those with modest or substantial means, the burden is automatically attached to the concept of our rights: how far is too far and how much is too much to exercise a constitutional right? But for those of us without a safety net, burden is a word that feels heavy. It sounds like the keys of a calculator clicking to determine whether this month’s math means we eat, have heat, and can put enough gas in our cars to get to work. That heaviness is the intersection of reproductive justice and economic justice, and it should be given equal weight in policy discussions, in advocacy, and in our media.

Just as SNAP funding provides a lifeline to those who need it, access and funding to reproductive health care provide a basic level of bodily autonomy and the opportunity to determine one’s own present and future. You can’t be a functional, autonomous human without the ability to eat, just as you can’t be fully human and free without the ability to control if, whether, and when you become a parent. These connections have long been clear and foundational to the reproductive justice movement built by women of color too-often sidelined and silenced by mainstream feminist and reproductive rights advocates. It’s long past time that their voices and approach to culture change became the standard for advocacy work.

Bodily autonomy is about more than just controlling what is happening right now in your reproductive system. Having final say over what happens within and around your body determines whether or not you are the one who decides the direction of your life. Ensuring self-determination for all people is the foundation to achieving economic justice; acknowledging this reality strengthens our movement and ensures that we strive to help people in need today as we secure the rights of everyone for the future.

In 1994, the California legislature passed a law with the hope of coercing poor mothers into having fewer children. Legislators evidently felt that the $122 a month that mothers received on average in welfare support for an additional child was encouraging poor mothers to have more children. The Maximum Family Grant Rule (also known as a family cap law) stripped these mothers, who were largely women of color, of this so-called incentive.

The Maximum Family Grant Rule added an exclusion to CalWORKs, California’s version of the federal Temporary Assistance for Needy Families program (commonly referred to as TANF), which provides poor expectant and recent mothers with cash support. It bars families who are already receiving CalWORKs assistance from obtaining additional support for a new child; the amount that a family receives thus remains unchanged. Similar family cap laws have been repealed in a handful of other states, but more than a dozen still have them on the books.

In California, a bill heading through the state legislature, SB 23, could soon repeal the Maximum Family Grant Rule after more than two decades. The California Senate passed SB 23 two weeks ago, and it is currently under consideration in the assembly. This is the third recent attempt to rescind the law; previous attempts have passed the assembly before dying in the senate. Since SB 23 has passed the senate it seems that a major hurdle has been overcome.

California’s Maximum Grant rule should be repealed first and foremost because of its discriminatory nature and demonization of poor women, particularly women of color, for having children and for requiring help from the government. The use of cash to attempt to influence parental birth decisions is also disturbing. However, there is a further argument to be made against the law: one of public health.

Family cap laws became popular during welfare reform in the 1990s, spurred by racist depictions of poor Black mothers as feckless parents and welfare queens who had children for the sole purpose of receiving government money. Family cap laws were intended to discourage families on welfare from having more children, with low-income Black women the primary targets. This rationale is still cited in support of them, even though research has found these policies have no such deterrent effect on the number of children individuals have.

Under the Maximum Family Grant Rule, mothers remain eligible for additional assistance only in the case of reported rape, incest, or contraceptive failures, although the accepted forms of contraception in this case are limited to an intrauterine device, a contraceptive shot or implant, or sterilization. (In other words, families with children conceived from the failures of birth control pills or condoms would not be eligible for more assistance.) These exceptions are themselves an issue: Many instances of rape and incest go unreported, and considering the history of sterilization ofpeople of color in the United States and particularly in California, this pressuring of mothers into long-term contraception is problematic.

Research—and common sense—demonstrates that these laws worsen child poverty. Nationwide, the cap has led to a 13.1 percent increase in deep poverty rates among children of single mothers and a 12.5 percent increase among single mothers. Its repeal would open additional support for more than 130,000 children in desperate need across California. This would have a significant effect on public health, as there is a clear correlation between childhood poverty and poor health outcomes, including obesity and diabetes, child mortality, and low birth weight. The impacts of childhood poverty continue into adolescence and adulthood, limiting children’s abilities to do well in school and increasing their risk of chronic disease in later life.

Lacking sufficient resources, many families are unable to buy the healthy foods they need, instead turning to cheaper, high-calorie but low-nutrition foods to keep them full. This increases chances of childhood obesity, diabetes, and other chronic diseases. Obesity rates are 1.7 times higher among poor children and teens, and while obesity rates have increased by 10 percent among all children age 10-to-17, obesity rates among low-income children have increased by 23 percent. A California study found that poverty is significantly associated with children being overweight, and, similarly, diabetes rates are highest in poorest communities.

Common consequences of poverty, including poor nutrition, high stress, and limited access to prenatal care, also increase the risk of child mortality and low birth weight. Low birth weight, in addition to increasing the likelihood of health problems among newborns, is associated with higher risks for obesity, diabetes, heart disease, and other chronic health conditions later in life. This is another avenue through which CalWORKs benefits could aid growing families: Small amounts of cash assistance to new and expecting mothers can help them pay for such essentials as prenatal visits that will have a lasting effect on their infants.

Solutions aimed at prevention are not only the ethical approach, but also the fiscally smart approach. From an economic perspective, increases in poor child health have significant cost implications for taxpayers. The annual cost of medical care for a child with diabetes is six times that of a child without the disease, and the average cost of Medicaid care for a child with obesity is $6,730 compared to $2,446 for all children.

The link between poverty and poor health is unambiguous. While public health advocates have focused on policies to expand access to food stamp programs and healthy foods, cash-based programs are also important. Much more can be done to back solutions that explicitly address poverty and inequality. Repealing the Maximum Family Grant Rule should be a priority, along with efforts such as raising the minimum wage and guaranteeing paid parental leave. The public health basis for supporting these campaigns is clear. By leveraging the science linking poverty with poor health and chronic disease, public health and human rights advocates can advance the case for poverty-reduction programs and effectively push for policy change—including the passage of SB 23.

This means, for example, that fast-food workers, earning prevailing Denver wages, would require a 62-hour work week to cover basic living expenses, as calculated by the Colorado Fiscal Policy Institute in another report based on EPI’s figures.

Denver janitors would need to work 51 hours per week to earn a livable income.

The two reports provide a comprehensive look at how much it costs to get by, going beyond poverty rates and other official measures, according to economist Elise Gould, who co-authored the EPI report. The minimum income for one person in Denver to “have a modest but adequate standard of living” is about $29,000, according to the EPI report. It’s about $99,000 for two parents and four children.

“Our family budgets are based on basic needs,” Gould told RH Reality Check. “They don’t include savings. There is no savings for college or retirement, outside of Social Security. There’s no rainy day fund. It’s a modest budget.”

“Those budgets don’t sound like very low-income budgets to most people, yet they are what’s required in lieu of a more expansive safety net,” Gould said, adding that her organization has prepared a similar analysis for Los Angeles.

Ari Armstrong, a Denver-based conservative blogger and commentator, said the EPI research failed to account for several economic factors. He charged that low-wage workers are simply adding to household income, and that they’re often not fully responsible for supporting a family.

“This is a very complicated issue in terms of getting to the root numbers; however upon a quick reading the study in question appears not to be taking into consideration all of the relevant facts,” said Armstrong, who has opposed programs helping low-income families purchase baby diapers. “For example, a fast-food worker may be supplementing family income, instead of being fully responsible for it. Usually people earning an introductory wage are contributing to the family budget, not bearing full responsibility.”

People ages 25-to-54 account for the largest share of fast-food worker jobs in the country, according to the Center for Economic and Policy Research. In states where the minimum wage is lower than $10.10 an hour, such as Colorado, 28 percent of low-wage workers have children.

The EPI report cites the “lack of significant wage growth over the past generation” as the “driving force behind growing inequality, the lack of significant progress in fighting poverty, and the general slowdown in improving living standards.”

“Congressional inaction on policies that might address this stagnation—such as raising the federal minimum wage—have encouraged a substantial number of states and cities to enact higher minimum-wage laws and explore other policies to lift worker pay,” the EPI report states. “These actions, while not eliminating the need for federal actions to lift wages, do help to ensure that regular employment provides the means to achieve a decent quality of life.”

Outside of wage increases, the public sector could provide more public housing, food stamps, expanded tax credits, and other interventions, Gould said.

By this summer, Gould said, EPI will have a tool on its website allowing residents of about 600 metro areas to enter their zip code and see how much it costs to live in their region. The organization has not decided how many detailed analyses, like those for Denver and Los Angeles, will be produced.

Los Angeles, the country’s second most populated city, will see its minimum wage increase to $15 by 2020 after the city council voted Tuesday for the wage hike, marking a major win for labor groups and working people who have seen the cost of living rocket past their hourly pay.

Los Angeles, the country’s second most populated city, will see its minimum wage increase to $15 by 2020 after the city council voted Tuesday for the wage hike, marking a major win for labor groups and working people who have seen the cost of living rocket past their hourly pay.

The city council will increase the city’s wages to $10.50 an hour by July 2016, followed by planned increases, according to the Los Angeles Times. The city council in 2014 approved a wage increase of more than $15 an hour for some 10,000 of the city’s hotel workers.

The citywide increase approved in a 14-1 vote on Tuesday will affect more than 700,000 workers in Los Angeles, according to some estimates. Los Angeles is the biggest city to raise its minimum wage above state levels.

“Today, help is on the way for the one million Angelenos who live in poverty,” said Los Angeles Mayor Eric Garcetti, who last year announced his own proposal to raise the city’s hourly minimum to $13.25 by 2017. This year, Garcetti threw his support behind the city council’s $15-an-hour plan.

Once the city’s minimum wage reaches $15 per hour in 2020, it will be roughly equivalent to $9.75 for the average American worker today, according to projections published by FiveThirtyEight. The cost of living for working people in LA is about 40 percent higher than in the average U.S. community, per FiveThirtyEight estimates.

The Los Angeles County Federation of Labor last January bought a series of billboards reading “Los Angeles: City Limited, Poverty Wage Pop. 810,864,” in conjunction with a report that found that the average pay for the city’s full-time, low-wage workers is $9.55 an hour, or about $19,000 a year.

One study by the Economic Roundtable, found that an increased wage would be exceedingly positive for the city, rebutting wage increase opponents who say a higher minimum wage will damage local economies and drive away businesses.

“We found that a phased-in increase to $15.25 by 2019 will put $5.9 billion more into the pockets of 723,000 working people, which will generate $6.4 billion in increased sales,” wrote Yvonne Yen Liu, one of the group’s researchers.

“That means that every dollar increase in the minimum wage generates $1.12 in economic stimulus,” Yen Liu wrote. “Businesses will hire more in response to the greater demand, creating 46,400 new jobs.”

Efforts to increase wages on the municipal level have gained traction across the country over the past few years, in part thanks to the Fight for $15 campaign, which seeks to draw attention to the low wages of fast-food workers.

In June 2014, Seattle became the first major city to pass a $15 minimum wage increase. Since then, a handful of cities across the country have enacted wage increases, including San Francisco, which passed a $15 hourly wage by ballot initiative in November, and Chicago, which approved an increase to $13 an hour.

New York Gov. Andrew Cuomo (D) this month announced that he plans to take executive action to push through a minimum wage increase for fast-food workers in the state, after Republican legislators opposed to a living wage cut a statewide increase from a budget proposal.

The fight for wage increases has more recently drawn in the technology world, after Facebook announced last week that it will increase the hourly wages of contractors to $15 minimum, as well as giving them 15 paid days of vacation.

Three in four adults favor a $12.50 national minimum wage, according to a survey released in January by Hart Research Associates. Ninety-two percent of those who identified as Democrats favored that higher minimum wage, while 53 percent of self-identified Republicans were proponents of the increase. Those in traditionally red states were slightly less likely to support a national minimum wage bump.

Los Angeles’ wage hike will face one more city council vote after the city attorney drafts a final plan.

The Wisconsin Public Service Commission approved changes to the state’s regulation of public utilities that will allow electric providers to nearly double their fixed rates in 2015. The changes were approved by commission members appointed by Gov. Scott Walker (R), just days after he won re-election campaigning against raising taxes and fees.

The rate changes were proposed by Wisconsin utility companies We Energies, Madison Gas & Electric, and Wisconsin Public Service Corporation (WPS). The utilities proposed an increase to the fixed monthly fee charged to customers, while reducing the usage-based kilowatt-hour charge.

The commission voted 2 to 1 to approve the changes. The change will increase the fixed electricity charge by about $9 per month and the fixed gas charge by about $8 per month.

Commissioners Phil Montgomery and Ellen Nowak, appointed by Walker, voted to approve the increase. Commissioner Eric Callisto, appointed by former Gov. Jim Doyle (D), opposed the change. Commissioners have six-year appointments, and must be confirmed by the state senate.

Wisconsin already has the second highest utility rates in the region, as customers in the state pay higher rates than Illinois, Indiana, and Ohio. Only residents of Michigan pay higher utility rates within the U.S. Energy Information Administration’s North Central region.

The change also comes just months after We Energies’ parent company bought the WPS parent for $9.1 billion. Walker praised that deal, saying that it would “result in better service for their local ratepayers.”

America’s poverty rate and gender pay gap have improved, but just barely, while median household income is at a standstill.

A new report from the Census Bureau on income and poverty found that the overall poverty rate in the United States decreased slightly, from 15 percent in 2012 down to 14.5 percent in 2013. The pay gap between women and men also technically improved, from 77 cents on the dollar to 78 cents—but that wasn’t a statistically significant change.

And with incomes still stagnating, experts say there’s still a long way to go to help struggling low- and middle-income families.

“The data reflect a grim reality for millions of women and their families, despite a welcome decline in the overall poverty rate,” Joan Entmacher, vice president for family economic security at the National Women’s Law Center, said in a statement.

Nearly 18 million adult women and 15 million children are living in poverty, and the poverty rates for both women and men overall were unchanged from 2012 to 2013. Median household incomes overall also stayed the same, as they have since 2011.

Child poverty dropped by nearly 2 percent, the first time since 2000 that child poverty has significantly decreased year to year. But those gains only went to children in married households or with a single father, not to children of single mothers. Black children were also the only racial and ethnic group whose poverty level did not decrease.

“Things are looking a bit better overall, but there are certainly groups who are not seeing improvement,” Kate Gallagher Robbins, senior policy analyst for family economic security at the National Women’s Law Center, told RH Reality Check.

The wage gap may partially explain the child poverty statistics for children of single mothers. “The wage gap is still as pernicious as ever,” Gallagher Robbins said.

The change from 2012 to 2013 wasn’t statistically significant, and the wage gap has hardly budged for the last decade. That’s mostly because wages have stagnated for both women and men during that time. But for the portion of the wage gap that may be explained by discrimination, women will get little help as long as Republicans in Congress continue to block legislation like the Paycheck Fairness Act.

Moreover, Gallagher Robbins said, comparing 2013 to 2012 confuses the bigger picture of how far the country has fallen in the past 14 years. The poverty level in 2000, before the first recession in that decade, was just 11.3 percent compared to today’s 14.5 percent.

The year the Great Recession started, 2007, was worse than 2000 but still better than today, with a poverty level of 12.5 percent.

Wages have a long way to go before they even recover to 2007 levels, much less 2000. Median wages overall have fallen 8 percent since 2007, and wages for African-Americans have fallen almost 14 percent.

There was some good news for Latinos, whose median wages got a 3.5 percent bump from 2012 to 2013. But their wages are still almost 9 percent lower than they were in 2007.

Valerie Wilson, director of the Economic Policy Institute’s program on race, ethnicity and the economy, told RH Reality Check that the modest income gains for Hispanic and Black populations this year are to be expected at this stage in the recovery, since historically disadvantaged groups are usually the last to recover from an economic shock.

This has major policy implications, she said. For instance, if the Federal Reserve thought the economy had recovered enough to raise interest rates, that would stifle job growth for those at the bottom just as they were starting to recover.

And keep in mind, she said: “Every group is still well below its pre-recession income levels.”

Poverty levels aren’t a force of nature, experts say, and we can influence them with public policy. For instance, restoring cuts to unemployment insurance could have resulted in even less poverty in 2013. And it’s likely because certain areas of the country raised their minimum wage that the bottom 10 percent of incomes were the only ones that didn’t fall between the first half of 2013 and the first half of 2014.

The Alaska legislature recently approved a project that will place free pregnancy tests in bar bathrooms as part of a larger campaign to raise awareness about fetal alcohol syndrome. But what is fetal alcohol syndrome, and could this effort possibly help address it?

Beginning in December, female customers in bars across Alaska will have access to an unexpected resource: pregnancy tests. The Alaska legislature recently approved a project that will place free tests in the bathrooms of 20 bars in the state. The study is part of a larger campaign to raise awareness about fetal alcohol syndrome, a spectrum of physical, mental, and behavioral disabilities long assumed to be caused by drinking to excess during pregnancy.

Alaska state Sen. Pete Kelly (R-Fairbanks), who earlier this year declared that “birth control is for people who don’t want to act responsibly,” is the driving force behind this new crusade. Alaska has one of the highest rates of fetal alcohol syndrome in the country. A 2010 report estimated that as many as 126 infants born each year in the state show signs of prenatal exposure to alcohol. But Kelly’s argument isn’t just a classic “think of the children” line. He claims fetal alcohol syndrome is responsible for a range of social ills, including suicide and domestic violence.

The logic behind the pregnancy test intervention is simple. Half of pregnancies in the United States are unplanned, so it’s possible that some patrons do not know they are pregnant when they order a beer or a shot of vodka. The pregnancy test is a nudge in the right direction—a reminder to make sure they’re not endangering a developing embryo.

Many states mandate posters in the bathrooms of bars or restaurants that warn about the dangers of prenatal alcohol consumption—“a pregnant woman never drinks alone”—but these signs have done little to curb the incidence of fetal alcohol syndrome, according to Robert Sokol, a professor of obstetrics and gynecology at Michigan’s Wayne State University. The researchers at the University of Alaska who are implementing the new study want to find out if a pregnancy test dispenser does a better job of getting women’s attention. The dispensers, originally piloted in Minnesota, have yet to be studied, so their effectiveness is still unknown.

Sokol says this approach is clever because instead of putting billboards on highways or doing a PSA blitz, the intervention is concentrated in bars, places where women could, according to Sokol, be engaging in risky behavior before they even know they are pregnant. “There hasn’t been much research on this issue that has focused in bars,” he says. “If a woman is pregnant and in a bar, then that’s someone we know is likely drinking, and it’s someone we should be talking to.”

Not everyone agrees. To others, this approach is a new riff on an old theme, one that has been frequently replayed since fetal alcohol syndrome was first given a name in 1973. In this refrain, concern about the mother’s well-being is submerged beneath fears about the harm she might inflict on her fetus. The initiative assumes that any pregnant woman in a bar is drinking alcohol, putting her in a place of public surveillance. “This kind of approach isn’t about empowering women to make healthy decisions—it’s about creating implicit responsibility for the outcomes of their pregnancies,” Farah Diaz-Tello, a staff attorney with National Advocates for Pregnant Women, told RH Reality Check. “It says that we’re concerned about women’s health only so that they can keep their bodies hospitable to pregnancy. If they don’t, they’re irresponsible—they’re bad mothers.”

The pregnancy test initiative is the brainchild of Jody Allen Crowe, the executive director of a Minnesota nonprofit called Healthy Brains for Children. Crowe, a former school superintendent with a master’s degree in public school administration, founded the group in 2008, shortly after self-publishing a book that claims to reveal “the undeniable connection between school shooters and their mother’s [sic] alcoholic behaviors.” Crowe, who is coordinating delivery of the pregnancy dispensers to Alaska and has served as a resource for legislators throughout the process, envisions a world in which taking a pregnancy test before drinking is as normal as designating a sober driver for a party: “We need to get the message out there that every drink a pregnant woman holds in her hand has the potential to take potential away from her child.”

The History of Drinking During Pregnancy

There was a time in the not-so-distant past when a statement like Crowe’s would have seemed outlandish—even misinformed. Alcohol was, throughout the mid-20th century, as much a part of a woman’s pregnancy as prenatal vitamins are today. A glass of port helped with sleep; some sherry before a meal could rouse an unwilling appetite. A cocktail and a cigarette could help an anxious mother-to-be relax. The only reason not to indulge to excess was the empty calories.

Some obstetricians even believed that alcohol could halt preterm labor. When women showed up at the hospital before their due date, complaining about steadily advancing contractions, doctors would send their patients home with instructions to drink a glass of wine. Others received pure alcohol intravenously in the hospital. In her book Conceiving Risk, Bearing Responsibility: Fetal Alcohol Syndrome and the Diagnosis of Moral Disorder, Princeton sociology and public policy professor Elizabeth Mitchell Armstrong writes that in doctors’ recollections, women subjected to this regimen “got so [they] smelled like a fruitcake.”

Attitudes toward alcohol consumption slowly began to change after 1973, when a group of doctors published a series of case studies in the medical journal The Lancet on children with development disorders, small eyes, unusually thin upper lips, and other abnormalities. The authors traced the cause for what they called a “tragic disorder” to maternal alcoholism. The women in the study had been dependent on alcohol for more than nine years; more than half experienced serious withdrawal symptoms. They were not the same women who were having a glass of port to help them sleep, but rather women who already struggled with serious alcohol dependency.

Over the following decade, public characterizations of fetal alcohol syndrome shifted, thanks to the flurry of research that followed the publication of the 1973 Lancet article. Thousands of studies on fetal alcohol syndrome were published between the mid-1970s and the late-1980s, many of which argued that the condition wasn’t just confined to women with severe alcohol problems. There was no clear consensus on how much alcohol was safe to drink, so women were told to abstain entirely.

The studies were, in general, small and inconsistent. The size of a drink was rarely defined—raising questions about whether women who reported their drinking habits were talking about a double shot of vodka or a glass of wine—and many included a handful of alcohol-abusing mothers, which may have skewed the sample. Other studies were performed on rats, who were given doses of alcohol that would have amounted to binge drinking in a human. It was clear that heavy drinking during pregnancy did carry a strong risk for fetal complications, but the evidence about light and moderate drinking during pregnancy remained unreliable. Nevertheless, alcohol consumption during pregnancy was increasingly represented, both in research papers and in the media, as an individual moral choice born of a mother’s selfish and reckless actions. Women needed to learn, in the words of a professor of dentistry writing in 1989, that “life is not a beer commercial.”

Faced with what was increasingly framed as a national crisis, policymakers sprang into action. In 1981, the surgeon general of the United States issued a warning to pregnant women, advising them “not to drink alcoholic beverages and to be aware of the alcoholic content of food and drugs.” Throughout the 1980s, states and localities launched public awareness campaigns about the hazards of alcohol consumption for expectant women. In 1988, the United States became the first and only country to mandate a warning label on alcoholic beverages outlining the dangers of drinking during pregnancy.

The Science Behind Fetal Alcohol Syndrome

Some women got the message. The numbers of women who drank any amount of alcohol during pregnancy declined from 32 percent in 1985 to 20 percent in 1988. Today, the number hovers around 12 percent. The number of women who binge drink during pregnancy, however, continues to hover between 2 and 3 percent. What, exactly, fetal alcohol syndrome is also remains a subject of great concern. In the United States today, the Centers for Disease Control and Prevention (CDC) estimates that anywhere between 1,000 and 40,000 babies are born with symptoms of the disorder each year. This wide range is only conjecture, in part because some states don’t require tracking of fetal alcohol syndrome diagnoses, making data collection difficult. But the numbers are also vague because the diagnostic criteria for the condition are subjective—there is no clinical test for fetal alcohol syndrome. Doctors screening for fetal alcohol syndrome are told to look for distinctive facial characteristics: thin upper lips and flat features. These obvious physical signs, however, only appear in children who were exposed to heavy drinking in utero.

The other assumed symptoms are more nebulous; they include growth problems (which often resolve themselves in early childhood), poor coordination and muscle control, cognitive defects, and developmental delays. These problems are hard to definitively attribute to prenatal alcohol exposure, because they could also be the result of poverty and a dysfunctional home life. Behavioral issues are also among the symptoms of fetal alcohol syndrome outlined by the CDC, although there is little concrete evidence to suggest that these problems are biologically linked to drinking while pregnant.

In one frequently cited study, researchers surveyed a group of 400 patients who were diagnosed with fetal alcohol syndrome at birth. These patients had a wide range of behavioral problems—ranging from inappropriate sexual behavior to incarceration to “disruptive school experiences”—but the authors admitted that they did not account for “environmental” factors like child abuse and neglect, living with an alcoholic parent, or being put into foster care. Yet environmental stressors likely had a profound influence on the study’s sample. Eighty percent of the respondents were not raised by their biological mothers.

Part of the problem is the lack of a clear distinction between the syndrome itself—a discrete collection of symptoms that include severe developmental disabilities and is associated with chronic alcoholic mothers—and other outcomes that may be associated with drinking but are also more difficult to diagnose and identify. Conflating the two suggests that they have the same cause, and also suggests that moderate drinking is the cause of the most devastating cases of fetal alcohol syndrome.

Because fetal alcohol syndrome is difficult to treat (and the small treatment programs that exist are underfunded), public health programming has focused mostly on convincing pregnant women not to drink. But part of the tension inherent in any prevention plan—like Alaska’s pregnancy test initiative—is the debate over who’s at risk. One of the most immediate challenges is that obstetricians themselves are not in agreement about how much alcohol can be safely consumed during pregnancy. The American Congress of Obstetricians and Gynecologists warns that “no amount” of alcohol is safe during pregnancy, but in a 2010 survey of OB-GYNs, only 60 percent agreed.

There’s a general consensus that binge drinking during pregnancy—consuming five or more drinks in one sitting—is risky. But the research still hasn’t proved that small amounts of alcohol cause ill effects. When University of Chicago economist Emily Oster was researching her book Expecting Better, she combed through hundreds of studies and found “basically no credible evidence that low levels of drinking (a glass of wine or so a day) have any impact on your baby’s cognitive development.” The few studies that showed negative birth outcomes as a result of light drinking were “deeply flawed.” Just as the research on patients affected by fetal alcohol syndrome failed to take environmental factors into account, these studies paid no heed to the complementary effects of other drugs. In one, many of the study’s “light drinkers” were also using cocaine.

The studies that have attempted to incorporate the effects of alcohol alongside environmental factors like poverty, instability, and use of other drugs have concluded that the women who are at risk for exposing their fetus to alcohol in utero are often low-income, with poor nutrition and little access to prenatal care. Some studies also show that cigarettes can exacerbate the negative effects of fetal exposure to alcohol.

In this context, the high incidence of fetal alcohol syndrome in Alaska—where Alaska Native women are five times as likely as non-Native women to give birth to a child with the condition—is less a result of women’s individual choices than a total breakdown of the social safety net. But instead of investing in the chronically underfunded Indian Health Service, the primary source of health care for most Alaska Natives, or devoting more funds to treatment programs that incorporate the loss of cultural integrity, which is also considered to be a major driver of alcoholism among American Indians, public awareness campaigns that target the entire Alaskan population are still the prevention tool of choice.

The emphasis on fetal alcohol syndrome as a problem that could afflict any child whose mother drank any amount of alcohol during pregnancy—rather than a symptom of severe substance abuse by relatively few women—makes it easier, says Janet Golden, a medical historian at Rutgers University, to justify solutions like signs or pregnancy tests in bathrooms—a cheap fix, compared to inpatient treatment for chronic alcoholics. These broadcast public health campaigns allow politicians to transfer responsibility for fetal alcohol syndrome onto the mothers themselves, rather than using state resources to help treat alcoholism and the other health problems caused by poverty and marginalization. “Women who drink during pregnancy are understood as willfully harming their fetuses,” Golden says. “There’s no acknowledgment that alcoholism is a severe health problem that’s killing women too. I don’t see any concern for those women’s ability to access care.”

Helping or Harming Women?

In the years after fetal alcohol syndrome was first diagnosed, attempts to discourage individual women from drinking during pregnancy have become increasingly punitive. In 1990, two years after the surgeon general’s warning began to appear on alcohol packaging, a pregnant woman in Wyoming seeking protection from her abusive husband was charged with felony child abuse after the police discovered she was drunk. Fears about “crack babies”—children born to low-income, minority mothers who were using cocaine—were also spiraling, and prosecutors were creative in using a wide range of statutes to charge women for actions that potentially harmed their fetus. Women found themselves facing accusations of abuse and neglect of children, “delivering” drugs to minors through the umbilical cord, and assault with a deadly weapon (cocaine). Most of these charges were struck down or reversed by judges who pointed out the logistical and constitutional questions they raised. How were women to know what counted as endangering their fetus? Could drinking coffee during pregnancy or missing a prenatal visit become a criminal act?

In response, policymakers turned to the civil code to reinforce penalties for drug and alcohol use during pregnancy. Eighteen states redefined civil child abuse to include prenatal substance use. Four states—Oklahoma, Minnesota, Wisconsin, and South Dakota—went further, passing laws that authorized involuntary civil detention of women who drank or used drugs while pregnant. The Wisconsin and South Dakota statutes allowed detention not just in the case of harm to the fetus—an ill-defined term under the best of circumstances—but when a woman’s alcohol use appeared to “lack self-control.” Alaska legislators have considered an involuntary commitment law for pregnant women who consume alcohol several times. Rep. Pete Kelly, the force behind the pregnancy test initiative, said earlier this year that such a measure isn’t out of the question in the future.

The brunt of these laws, which are vaguely written and selectively applied, falls on low-income women and women of color. A study published in 2010 by Lynn Paltrow, the executive director of National Advocates for Pregnant Women, and Jeanne Flavin, a sociology professor at Fordham University, found that Black and Native American women were disproportionately represented among the pregnant women arrested or subjected to a forced medical intervention because of substance use. Only about 10 percent of the claims against the 413 women in the National Advocates for Pregnant Women study were related to alcohol—most of the time, the substance in question was cocaine—but they established a strong precedent for health providers, social workers, and even neighbors to report women who were drinking during pregnancy.

This is especially true in Alaska. Rosalie Nadeau, the CEO of Akeela, the state’s largest residential treatment provider for pregnant women, says that most of the women in her programs were reported to child protective services, which usually triggers a custody dispute. “The ones who have children have usually either lost their kids already or are in danger of losing them,” Nadeau says.

The pattern of reporting women for substance use would be less troubling if there were more programs like Akeela, which offers a range of residential and outpatient services for women with children. Part of Akeela’s goal is to help women achieve sobriety so that they can regain lost custody rights. But policymakers have failed to pursue treatment with the same zeal that they have approached punishment. Only 18 states have created or funded programs specifically targeted at pregnant women with substance abuse problems, and the waiting list is always long. Nadeau’s program, despite being the biggest in Alaska, can only accommodate 15 women at a time. Any more, and Akeela risks losing the Medicaid dollars that keep its treatment centers open.

The dearth of funding for treatment programs like Akeela is alarming, considering that women with entrenched alcohol abuse problems are at highest risk for giving birth to a child affected by fetal alcohol syndrome. These women, chemically dependent on alcohol, are unlikely to stop drinking because of a pregnancy test in a bathroom.

But helping a targeted minority of women is not the goal of the new Alaska study. “This intervention is not specifically intended for women who have chronic alcohol problems,” David Driscoll, an associate professor of health and social welfare at the University of Alaska and the lead researcher on the project, told RH Reality Check. “It’s intended for those women who are not aware yet that they’re pregnant and are not aware of the risks of [fetal alcohol spectrum disorder].”

Margo Singer, vice president of the National Association for State Fetal Alcohol Syndrome Disorder Coordinators, says that fetal alcohol syndrome prevention requires a variety of approaches. There are universal campaigns—like the pregnancy test dispensers—that attempt to raise awareness. Then there are more carefully tailored strategies, which educate family planning professionals, doctors, and social workers about how to talk to women about the dangers of alcohol abuse. Finally, there are counseling programs for women in alcohol treatment programs, which emphasize contraception alongside warnings about the harm associated with heavy drinking during pregnancy.

In a perfect world, Singer says, there would be funding for all of these initiatives. But since 2012, federal dollars for fetal alcohol syndrome prevention were slashed. The $400,000 allocated for the pregnancy test intervention is, in this climate, a tidy sum. The University of Alaska researchers’ plan to determine whether the dispensers work will be a new addition to the literature on fetal alcohol syndrome prevention. But they may find that the intervention, like the bathroom signs, simply doesn’t work. “If it helps one woman, that’s a good thing,” says Singer. “But we do have to ask the questions: Is this effective? Has it been tested? Is this really the initiative we want to promote?”

In a state with a budget deficit, David Driscoll notes that it’s “laudable” that Alaska legislators allocated money for fetal alcohol syndrome prevention. The pregnancy dispenser project will be accompanied by a statewide public awareness campaign and a program targeted at Alaska Natives in remote parts of the state. But Rosalie Nadeau questions why the state is investing in a program that has yet to be tested, when treatment for alcohol abuse is chronically underfunded.

There’s near-uniform agreement that access to free pregnancy tests will be good for women, regardless of the context. But the Alaska initiative doesn’t include money to provide contraception, which Singer says is a crucial part of any effort to reduce fetal alcohol syndrome. A study conducted by researchers in Washington state revealed that 81 percent of women at risk for fetal alcohol syndrome had no birth control, although 92 percent wanted some form of contraception. Driscoll says that condoms will be available alongside the pregnancy test dispensers, although he did not specify how they would be funded. The contraception will be added separately, because when Jody Allen Crowe first piloted the program, birth control was not part of his design. “It’s just not our goal,” he says. “We want to stop alcohol during pregnancy. We don’t want to stop the pregnancies themselves.”

This, according to Golden, does a fundamental disservice to women who might take steps to prevent pregnancy if they had the education or the resources. “Historically, there’s been an expectation that women are so primed to be mothers that if they see a pregnancy test or take it, they’ll stop drinking immediately,” she says. “The women who are chronic alcoholics can’t, so we label them bad mothers. A lot of these women would stop drinking during pregnancy if they could. We just don’t give them the resources and care they need to do it. It’s something we see again and again. We keep going for the inexpensive fix that doesn’t actually solve the problem.”

The withdrawal of public services in Detroit is typically framed as an unavoidable response to the city's declining tax base. Alternatively, we frame these violations as an active assault against communities of color and low-income families in the interest of white-controlled financial institutions.

Every morning Kendra pushes her cart several blocks to a friend’s house, where the water has not yet been shut off. After filling various jugs and trash bins, she then makes the lengthy trip home, passing vacant lots and abandoned homes that now characterize many neighborhoods in Motown’s urban center.

When we first heard Kendra’s story, Elizabeth was transported back to Kasese District, a rural area in Western Uganda where she once worked as a maternal health fellow. She saw the never-ending parade of women carrying jerry cans heavy with water from the lakes to their thatch-roofed homes. Like Kendra, their daily journey was not an exercise in futility but, rather, an act of survival. Water is critical for their families’ hydration, cooking, and sanitation—just as it is for Kendra. Such a basic need is universal to the human race, after all.

In Detroit, stories like Kendra’s are far too common. And her story, like those of the women in Kasese, is typically isolated outside the historic and political contexts from which they spring. Instead of resourceful agents reacting to unjust living conditions, Detroit residents are labeled as “delinquent customers” who “opt not to” pay their water bills. But these are not irresponsible behaviors acted out by immoral individuals. They are the result of structural-level processes, which exist at the intersection of neoliberal capitalism, racialized exploitation, and sexism. Nevertheless, the Detroit Water and Sewage Department (DWSD) has continued to shut off water to low-income families instead of more powerful (and financially capable) account holders such as the State of Michigan or the Palmer Park Golf Club, whose outstanding debts swamp those of individual households. (On Monday, however, DWSD issued a temporary suspension of shutoffs for 15 days to give residents time to seek help in bringing their accounts current.)

Leaders in the reproductive justice movement have called for the centering of race and women of color’s lived experiences in order to achieve true reproductive freedom for all. Using this framework, we can explore why the water shutoffs in Detroit—one of the nation’s most racially segregated cities—should deeply concern reproductive justice advocates.

Historical and Sociopolitical Backdrop

At the turn of the 20th century, Europe’s colonization of East Africa was characterized by depletion of resources, exploitation of communities of color, and underinvestment in social infrastructure. With haunting similarity, we now stand witness to these same global, political-economic forces devastating urban centers across the United States. While certainly not an outlier (38 U.S. municipalities have filed for bankruptcy since January 2010), Detroit serves as a striking example of the threats to come—particularly for vulnerable groups such as women and children who are low-income and/or Black and/or Latino.

In Detroit, the cost of water is nearly twice the national average, and approximately half of the city’s customers owe outstanding balances on their water bills. But let’s situate this against a broader historical and sociopolitical backdrop. By 2011, half of Detroit’s working-age population was unemployed, and only 27 percent had full-time work. Nearly one in five Detroit residents were below the poverty line. Approximately three in five children were living in households headed by single mothers (see Rose Brewer’s article on the prison industrial complex). Moreover, these statistics are significantly worse for the city’s Black and Latino residents.

This scenario is one outgrowth of globalization, racial discrimination, and subsequent withdrawal of city services. Michigan’s auto industry has been in decline since the 1970s, following globalization of auto manufacturing and markets. As was typical in the Rust Belt, this economic shift toward deindustrialization was quickly succeeded by white flight from Detroit’s urban center. In turn, this led to rapid suburbanization of both population and employment opportunities in the greater metro area. Subsequently, Black families like Kendra’s now live in neighborhoods suffering from the increasing withdrawal of vital public services including police, emergency medics, fire fighters, and streetlights. Water shutoffs are simply the most recent violation they’ve faced.

We can follow threads of the exploitation of communities of color in both Kasese, Uganda, and Detroit, Michigan, which has the highest percentage of Black residents in the United States (84 percent). In both locales, populations of color have faced similarly devastating consequences from the inherently intertwined systems of capitalism and racism. For example, both have suffered diminished access to basic necessities like water. In contrast, both white colonialists and white suburbanites have reaped magnificent wealth from their control and exploitation of Black labor. The withdrawal of public services in Detroit is typically framed as an unavoidable response to the city’s declining tax base. Alternatively, we frame these violations as a deliberate assault against communities of color and low-income families in the interest of white-controlled financial institutions.

The Shutoffs and Reproductive Health and Autonomy

Such environmental and social stressors are likely to carry significant consequences for the health of racially and economically marginalized women and their children. For example, countless studies have documented how experiences of racism and poverty contribute to cumulative wear and tear on the body over the course of a person’s life. This increased “allostatic load” has been linked to poorer reproductive and health outcomes, including premature birth, low birth weight, and infant mortality.

But perhaps more importantly, water shutoffs parallel the pervasive and life-long assaults against personal autonomy endured by women, particularly those from marginalized communities. As the United Nations recently declared, “Disconnection of water services [in Detroit] because of failure to pay due to lack of means constitutes a violation of the human right to water and other international human rights.”

We would argue that these water shutoffs also violate the human right to reproductive freedom. From the 1994 International Conference on Population and Development, UN delegates defined reproductive health as “a state of complete physical, mental and social well-being.” This implies individuals must have “the capability to reproduce and the freedom to decide if, when and how often to do so.” More explicitly, it requires “the means to do so” such that couples have “the best chance of having a healthy infant.” Clearly, the DSWD’s water shutoffs for poor families are a violation of this international agreement.

Political pundits—who, notably, have access to potable water and are not from Detroit—are currently shaming low-income Detroiters affected by the water shutoffs. Reporters, analysts, and the public are questioning why Detroit residents spend their money on nonessential items instead of water. They suggest conditional requirements for service reactivation such as the monitoring of water consumption and financial expenses among poor families.

Such patronizing statements are not made about golf clubs.

Sadly, this infantilization is a familiar experience for Black women on public assistance, who are often accused of being “welfare queens” and “crack mothers.” But like the high-income DWSD account holders in Detroit, similar judgments are never made of large businesses that receive tax breaks, subsidies, and other forms of corporate welfare.

Like their financial decisions, the reproductive choices made by low-income Detroit residents are highly scrutinized. Generally, women are blamed for “irresponsible” reproductive outcomes, whether that is having children (if you are poor or non-white) or not having children (if you are affluent and white). More specifically, Black and Latina women who receive welfare, Medicaid, or other “entitlements” are painted as lazy, greedy, and neglectful mothers. They are accused of scamming the system and criticized for “not working” as though child-rearing and domestic labor is not “work.” Of course, this is old news: “feminine” work is seen as inferior to “masculine” work and is, therefore, not compensated equally, if at all.

In turn, low-income women are caught in a treacherous double bind. They are socialized and expected to perform the important but un- or underpaid reproductive labor of keeping children and home. Simultaneously, neoliberal “budget cuts” mean they are denied resources necessary for their families’ survival, including housing, food, and water. Together, the lack of economic compensation for reproductive labor combined with decreased welfare benefits makes it impossible for low-income mothers to keep up with the rising costs of living. Viable options are further eroded for families of color, who experience significant racial discrimination in access to both education and employment. How do we expect low-income women of color to mother under such conditions?

Some researchers, including Arline Geronimus, have examined traditional American ideology, which is highly critical of both Black and teen motherhood. They have found that Black women who bear children as teenagers experience better birth outcomes (for example, lower infant mortality) in contrast to white women whose risk is highest for poor birth outcomes during adolescence. This disparate health pattern (what Geronimus calls “weathering”) is the result of “premature aging” in Black women, who accumulate exposure to sexualized racism over their life course. Similarly, this “weathering” contributes to generalized premature mortality within Black communities, which diminishes women’s familial support for child-rearing as they age. In turn, Geronimus and others have suggested that the denigration of Black teen mothers overlooks structural constraints that require this adaptive practice. Similarly, the attribution of water “delinquency” to individuals’ irresponsible (even illegal) behavior is nothing short of victim-blaming.

The Way Forward

As urban planner Jamie Peck once proclaimed during a lecture for the Detroit School of Urban Studies, we cannot use capitalist tools to dismantle the crisis created by capitalism. Detroit Emergency Manager Kevyn Orr is currently considering various bids to privatize the DWSD. But such privatization is likely to increase rates for Detroit residents and (like other forms of fiscal austerity) seeks to squeeze the last drops of life from a well that is already dry.

Instead, protesters and human rights activists have emphasized how investment in public services can lift residents out of desperation and increase their freedoms and capabilities. For example, the State of Kerala has significantly better health outcomes than other regions in India, although its income per capita is below the national average. Human and reproductive rights leaders, including Gita and Amartya Sen (who are not related but share the same last name), have attributed this anomaly to Kerala’s historic investment in social infrastructures that improve the agency of its residents. These include state support of education, health services, and women’s empowerment in addition to basic needs like food and water.

Short-sighted solutions disconnected from historical and sociopolitical contexts are likely to exacerbate suffering and inequality in Detroit.

If you are interested in donating your time, energy, or money to the activists and residents fighting for their human right to water, you can connect here for information about the Peoples Water Board.

]]>http://rhrealitycheck.org/article/2014/07/22/water-water-everywhere-racial-inequality-reproductive-justice-detroit/feed/2‘Water Is a Human Right': Advocates Call for End to Detroit Water Shutoffshttp://rhrealitycheck.org/article/2014/07/17/water-human-right-advocates-call-end-detroit-water-shutoffs/?utm_source=rss&utm_medium=rss&utm_campaign=water-human-right-advocates-call-end-detroit-water-shutoffs
http://rhrealitycheck.org/article/2014/07/17/water-human-right-advocates-call-end-detroit-water-shutoffs/#commentsThu, 17 Jul 2014 20:33:35 +0000http://rhrealitycheck.org/?p=42350

Despite being surrounded by the largest collection of freshwater lakes in the world, thousands of Detroit residents—most of them low-income people of color—are finding themselves without access to fresh water because of actions by the city's water department that advocates say are in violation of Detroiters' human rights.

Despite being surrounded by the largest collection of freshwater lakes in the world, thousands of Detroit residents—most of them low-income people of color—are finding themselves without access to fresh water because of actions by the city’s water department that advocates say are in violation of Detroiters’ human rights.

In March, the Detroit Water and Sewerage Department (DWSD) announced an effort to collect more than $119 million in delinquent payments from more than 150,000 customers in an effort to reduce the department’s $5.7 billion debt load—which it acquired after the city, and then its water and sewage bonds, were downgraded by multiple major credit agencies. As part of that plan, in April and May the department shut off water service at a total of 7,556 locations. In June, the department redoubled those efforts, shutting off service at 7,210 locations in one month alone.

Community advocates have spoken out against these tactics, and have organized to protest policies that they say are denying residents a basic human right to water.

DWSD has targeted properties that have bills that are at least two months delinquent and owe at least $150. But, according to the department, it only disconnects service to some of the properties that receive shutoff notices. For instance, in May DWSD says it sent out 46,000 shutoff notices but only disconnected service for about 4,500 customers. The department says this is because of staff shortages (in January, DWSD eliminated 600 jobs as part of a restructuring of the department), though the disconnections are being performed by a private contractor. The department also says that the majority of customers who have their water shut off experience a disruption in service for less than a day, because most people pay their bill soon after the shutoff begins.

Sheffield told RH Reality Check that she voted against the increase because she believes there are issues the DWSD should address first before increasing the water bills of residents. “There have been several calls to my office from people who have been paying their bills and are getting shutoff notices,” said Sheffield. “People are also complaining about vacant homes with running water that can help drive up cost, that the department is now seeking residents to pay for.”

In recent years, Detroit has gone through a drastic period of depopulation, in large part due to the economic effects of the loss of manufacturing jobs coupled with the subprime mortgage crisis, which has led to an unusually large number of vacant homes for a major U.S. city.

Many of the residents in the district that Sheffield represents have come to her with complaints about the water department’s collection efforts. She’s heard from residents who claim to have paid their bill in full but still received shutoff notices, and residents who have attempted to make payments on their bill but cannot afford the steep late fees. Sheffield’s District 5 is the most diverse in the city. Thirty-nine percent of the district’s residents are Black, and 38 percent are Latino; they are also the poorest residents in the city, with a per capita annual income of $16,753.

The department’s aggressive collection efforts have led advocates to form the People’s Water Board Coalition, which is advocating for access to and the protection and conservation of water for Detroit residents. The coalition comprises a number of community groups, including social justice, environmental, labor, and conservation organizations.

Tawana Petty, a spokesperson for coalition member Detroiters Resisting Emergency Management, told RH Reality Check that she believes that the actions of the DWSD are part of a larger effort to privatize the city’s water by Emergency Manager Kevyn Orr, who she says has a “dictatorship” over Detroit.

The DWSD has also been criticized for targeting residential customers much more aggressively than commercial ones throughout the spring and early summer. On July 9, the department announced that it would increase collection efforts of delinquent commercial customers, with DWSD Deputy Director Darryl Latimer noting that commercial accounts made up 12 percent of the accounts that remained delinquent at that time.

Greg Eno, public affairs specialist with the DWSD, told RH Reality Check in an email that currently there is $89 million owed on some 91,000 delinquent accounts. Of those accounts, 80,000 are residential and 11,000 are commercial. Despite the significantly smaller number of delinquent commercial accounts, commercial customers represent more than half of the money that the city is seeking to collect: $46 million, compared to $43 million to be collected from residential customers.

Shea Howell, another spokesperson from Detroiters Resisting Emergency Management, says the department is only going after the commercial accounts now because of public pressure. “The motivation is the desire to make the water department more attractive either for sale or for a private-public partnership as part of the bankruptcy proceedings,” Howell told RH Reality Check.

The shutoffs could have a significant effect on public health, in a city that is already facing significant public health issues. “Of course it poses a true public health issue when you’re talking about water,” said Council member Sheffield. “Water is a human right. If you’re cutting off access to people’s clean running water, there definitely is a public health issue.”

Sheffield sees some improvement with how the DWSD has handled the collection effort, but still sees room for improvement. She cited the department’s Detroit Residential Water Assistance Program (DRWAP), which is designed to help customers who have trouble affording their water bill. According to a DWSD press release, there are currently more than 17,000 customers enrolled in a DRWAP payment plan program designed to fit each customer’s financial situation and ability to pay. The program requires that residents “make some kind of contribution toward their accounts” before they can qualify for assistance. Eno told RH Reality Check that the “contributions” can be as low as $20 or $30 per month, but are “determined on a case-by-case basis.”

Individuals eligible for the Detroit Residential Water Assistance Program must live in single-family dwellings in the city, have received a shutoff notice, and be at or below 200 percent of the federal poverty line or participating in public-assistance programs. The home also must have a new automatic meter reading (or AMR) meter installed.

Some advocates see these criteria as creating an inappropriately high barrier to entry into the program. “They are really being given the run around,” said Petty. She also noted that some residents have reported being told incorrectly that they have to meet criteria that are not part of the program. “They are being told that you have to have a valid ID, you have to have ownership of the property, you have to have an income,” she said.

Petty says that while the DWSD is trying to create a narrative that the department is helping people with the program, the reality is that many residents are unable to receive assistance.

Many advocates see the city’s actions as part of a long history of racial inequality in the city since low-income residents and people of color have been disproportionately affected by the water shutoffs.

The population of Detroit is 82.7 percent Black, with a median household income of $26,955 and 38.1 percent of residents living below the poverty line. The city also has the highest unemployment rate in the nation, at 23 percent.

Oakland County, one of Detroit’s suburban counties, is 76.7 percent white, with a median household income of $65,637; it is the richest county in state.

DWSD Director Sue McCormick was quoted in a press release saying she wants to make it clear that while there are a large number of delinquent water accounts in Detroit, those delinquencies will not affect suburban water bills. “Unpaid Detroit water bills affect only Detroit customers,” McCormick said. “No suburban customers pay any extra on their bills to make up for unpaid bills on Detroit addresses.”

Petty views this as coded language meant to assuage the concerns of white, wealthy suburban residents.

A growing chorus is calling for action to address Detroit’s water crisis. A report from Demos characterized the program as “mass enforcement to discipline the people” and as a “misuse of the right to deny service.” The United Nations released a statement saying that “disconnecting water from people who cannot pay their bills is an affront to their human rights.” Rep. John Conyers (D-Detroit) called on President Obama to take “immediate federal action and local relief for the water crisis impacting thousands of Detroiters.”

To bring attention to the crisis, the People’s Water Board Coalition is organizing a march and rally Friday. Assembling at the Cobo Convention Center, organizers will join with local residents, clergy, and progressive activists from the Netroots Nation conference. They plan to march to Hart Plaza in downtown Detroit, a block from City Hall, calling for a moratorium on all water service shutoffs and adoption of the Detroit Water Affordability Plan, created by the Michigan Welfare Rights Organization, which proposes a combination of affordability programs, consumer protections, and water conservation efforts.

A new report says that the federal government is the largest funder of low-wage jobs for working women and people of color, and that President Obama should take executive action to help lift them into the middle class.

A new report says that the federal government is the largest funder of low-wage jobs for working women and people of color, and that President Obama should take executive action to help lift them into the middle class.

The report, Underwriting Good Jobs, details how 8 million workers and their families, or more than 20 million Americans overall, depend on low-wage jobs that are significantly funded by taxpayer dollars. A disproportionate number of those low-wage employees are women (71 percent) and minorities (44 percent).

“Today, addressing the needs of women in the workplace means addressing the needs of low-wage workers,” Liz Watson, senior counsel at the National Women’s Law Center, said during a press call accompanying the report’s release. Poverty-level wages and difficult working conditions such as pregnancy discrimination, lack of paid sick leave to care for family members, and unpredictable schedules, Watson said, “not only hurt women, they also hurt the families who are dependent on them.”

Monica Martinez, a working mother of two who makes $12 an hour serving food at Washington, D.C.’s Union Station and also holds a second job, said she is grateful to the president for raising the minimum wage for federal contractors, but that it’s “not enough for working moms like me.” She struggles to afford college tuition for one child, and said that benefits like paid sick days and the right to form a union could empower her to leave her second job and spend more time with her kids.

The middle class is shrinking, most income gains are going to the top 1 percent, and tens of millions of Americans face stagnating wages and a “crisis of living standards,” according to the report. President Obama’s recent executive orders that addressed the gender wage gap and raised the minimum wage in new federal contracts to $10.10 an hour starting in 2015 were important first steps, the authors said. But a “bolder course of action” is needed to lift more Americans, especially women and minorities and their families, out of poverty and into the middle class.

Because the $1.3 trillion “federal footprint” of spending in the private sector is so big, the report says, and because so many private companies depend on the federal government for at least 10 percent of their revenues, a federal “Good Jobs Policy” would incentivize private companies to do better by their workers if they want to effectively compete for federal contracts. If the president ordered such a policy through executive action, agencies would incorporate the policy in their decisions to award and evaluate federal contracts and other spending.

Such a policy, the report says, should favor companies that respect employees’ right to collectively bargain; offer living wages, health care, paid sick leave, and predictable work schedules; comply with workplace protection laws; and limit executive compensation to 50 times the median worker’s salary.

Implementing these policies, the report said, would be hugely beneficial both to workers and to the U.S. economy. Those 20 million people dependent on low-wage, taxpayer-supported jobs could see their standard of living increase by 20 percent. Moreover, GDP would grow by $31 billion annually, and because more people would be lifted out of poverty, the federal government would save billions on programs like Medicaid, SNAP (the Supplemental Nutrition Assistance Program, or food stamps), and the Earned Income Tax Credit.

Most of the industries that the report deems “federally dependent,” or that make at least 10 percent of their revenue from the government, employ people like nurses, home health-care workers, janitors, landscapers, security guards, cashiers, and sales associates.